Mrs. Munoz was 14 weeks pregnant, the doctor said, and Texas is one of more than two dozen states that prohibit, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient.

FORT WORTH — The diagnosis was crushing and irrevocable. At 33, Marlise Munoz was brain-dead after collapsing on her kitchen floor in November from what appeared to be a blood clot in her lungs.

But as her parents and her husband prepared to say their final goodbyes in the intensive care unit at John Peter Smith Hospital here and to honor her wish not to be left on life support, they were stunned when a doctor told them the hospital was not going to comply with their instructions. Mrs. Munoz was 14 weeks pregnant, the doctor said, and Texas is one of more than two dozen states that prohibit, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient.

More than a month later, Mrs. Munoz remains connected to life-support machines on the third floor of the I.C.U., where a medical team monitors the heartbeat of the fetus, now in its 20th week of development. Her case has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion — when life begins and how it should be valued.

“It’s not a matter of pro-choice and pro-life,” said Mrs. Munoz’s mother, Lynne Machado, 60. “It’s about a matter of our daughter’s wishes not being honored by the state of Texas.”

Mrs. Munoz’s father, Ernest Machado, 60, a former police officer and an Air Force veteran, put it even more bluntly. “All she is is a host for a fetus,” he said on Tuesday. “I get angry with the state. What business did they have delving into these areas? Why are they practicing medicine up in Austin?”

Mrs. Munoz’s parents said they wanted to see the law overturned, but they have not sought any legal action against the hospital, though they have not ruled it out either.

The hospital maintains that it is following the law, although several experts in medical ethics said they believed the hospital was misinterpreting it. A crucial issue is whether the law applies to pregnant patients who are brain-dead as opposed to those in a coma or a vegetative state. The law, first passed by the Texas Legislature in 1989 and amended in 1999, states that a person may not withdraw or withhold “life-sustaining treatment” from a pregnant patient.

Mr. and Mrs. Machado said the hospital had made it clear to them that their daughter was brain-dead, but hospital officials have declined to comment on Mrs. Munoz’s care and condition, creating uncertainty over whether the hospital has formally declared her brain-dead.

A spokeswoman for the J.P.S. Health Network, the publicly financed hospital district in Tarrant County that runs the 537-bed John Peter Smith Hospital, defended the hospital’s actions. “In all cases, J.P.S. will follow the law as it applies to health care in the state of Texas,” the spokeswoman, Jill Labbe, said. “Every day, we have patients and families who must make difficult decisions. Our position remains the same. We follow the law.”

Ms. Labbe said that neither she nor the doctors could answer questions about Mrs. Munoz’s condition because her husband had not signed the paperwork allowing them to speak to the news media about his wife’s care.

At least 31 states have adopted laws restricting the ability of doctors to end life support for terminally ill pregnant women, regardless of the wishes of the patient or the family, according to a 2012 report from the Center for Women Policy Studies in Washington. Texas is among 12 of those states with the most restrictive such laws, which require that life-support measures continue no matter how far along the pregnancy is.

Legal and ethical experts, meanwhile, said they were puzzled by the conflicting accounts of her condition. Brain death, an absence of neurological activity, can be readily determined, they said. It is legally death, even if other bodily functions can be maintained.

“If she is dead, I don’t see how she can be a patient, and I don’t see how we can be talking about treatment options for her,” said Thomas W. Mayo, an expert on health care law and bioethics at the Southern Methodist University law school in Dallas.

Critics of the hospital’s actions also note that the fetus has not reached the point of viability outside the womb and that Ms. Munoz would have a constitutional right to an abortion.
Recent Comments
workerbee
15 minutes ago

"A spokeswoman for the J.P.S. Health Network, the publicly financed hospital district in Tarrant County that runs the 537-bed John Peter...
David
28 minutes ago

And what becomes of the baby once he/she is born?
Soni
28 minutes ago

This is not Federal law intervening in this case, it is state law. Big difference!

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The restrictive measures were largely adopted in the 1980s, with the spread of laws authorizing patients to make advance directives about end-of-life care like living wills and health care proxies, said Katherine A. Taylor, a lawyer and bioethicist at Drexel University in Philadelphia. The provisions to protect fetuses, she said, helped ease the qualms of the Roman Catholic Church and others about such directives.

“These laws essentially deny women rights that are given others to direct their health care in advance and determine how they want to die,” Ms. Taylor said. “The law can make a woman stay alive to gestate the fetus.”

In Texas, the law and the hospital’s efforts to abide by it have drawn support among opponents of abortion. “The unborn child should be recognized as a separate person,” said Joe Pojman, executive director of Texas Alliance for Life. He added, “I would say that, even if she were brain-dead, I would favor keeping treatments going to allow the child to continue to survive, with the hope the child could be delivered alive.”

Jeffrey P. Spike, professor of clinical ethics at the University of Texas medical school in Houston, said there were some known examples of fetuses having been kept alive while a terminally ill or brain-dead mother was on a respirator. But in every case he knew of, he said, those steps were in line with the family’s wishes.

Mrs. Munoz’s parents and her husband, Erick Munoz, 26, remain in limbo, even as they and other relatives help care for the Munozes’ 15-month-old son, Mateo.Mr. Munoz has returned to his job as a firefighter but continues to sit by his wife’s side at the hospital. She had been due to give birth in mid-May, but the hospital’s plans for the fetus — as well as its health and viability — remain unknown. Mr. Machado said he had been told by the hospital’s medical team that his daughter might have gone an hour or longer without breathing before her husband woke and discovered her, a situation he believes has seriously impaired the fetus. “We know there’s a heartbeat, but that’s all we know,” he said.

Mrs. Machado said the doctors had told her that they would make a decision about what to do with the fetus as it reached 22 to 24 weeks, and that they had discussed whether her daughter could carry the baby to full term to allow for a cesarean-section delivery. “That’s very frustrating for me, especially when we have no input in the decision-making process,” Mr. Machado added. “They’re prolonging our agony.”

On Tuesday afternoon, in the rural community about 30 minutes outside downtown Fort Worth where they live, Mr. Machado and his wife took care of Mateo while the boy’s father was at work in Crowley. As he held Mateo in his arms, Mr. Machado recalled touching his daughter’s skin as she lay in the hospital.

“She felt more like a mannequin,” Mr. Machado said. “That makes it very hard for me to go up and visit. I don’t want to remember her as a rubber figure.”
*****
Correction: January 8, 2014
An earlier version of this article misspelled the given name of a lawyer and bioethicist at Drexel University. She is Katherine A. Taylor, not Katharine.
*****

By: Manny Fernandez reported from Fort Worth and Erik Eckholm from New York | The New York Times |

Wednesday January 8, 2014, 8:14 am
horrible......and I just want to say to anti-choice advocates "if the baby (fetus) is capable of being alive, why don't you let the baby be born now?"....oh because its not capable of life until at least 24 weeks.....so again, nothing certain in life....therefore, let women (and their partners when involved) make up their own decisions rather than trying to enforce your beliefs....

Wednesday January 8, 2014, 1:56 pm
Sad case and I'm sorry for what the family is going through. To me though, there is a big difference between wishing "not to be left on life support" when it is only your own life in question and wishing the same thing if you are pregnant and had been intending to eventually give birth. Wouldn't most parents (or parents-to-be) say to give their child preference over their own needs? Without any evidence to the contrary, wouldn't you think this mother would have said to keep her body alive as long as there is any chance her child could live? I am pro-choice, but, in this case, since there is no way the mother can choose, we have to give the fetus a chance.

The woman left a DNR, now that would stand for any man. This woman could have been released from more weeks of knowing nothing but pain if her wishes were granted as they would be in 26 states. To keep her alive, till the child is of sufficient weight and growth to be removed from her, we have no idea what problems that child will confront, other than being born to a dead mother.

Wednesday January 8, 2014, 2:29 pm
I agree, Kit - who is to say the baby will even be a healthy one IF it is (ahem) carried to term? A DNR is a DNR - what's the point if it's not followed? We can all feel for the family but for me, keeping this mother alive under these conditions is macabre.

Wednesday January 8, 2014, 3:47 pm
I am no "pro-lifer" but I agree she should be kept alive until the fetus is full-term. If that child was planned and wanted, he/she should be given at least a fair chance.

Wednesday January 8, 2014, 8:45 pm
Roger Skinner is wondering why the fetus should not be given a chance. While most mothers would want their child to be born often even after they are in a bad state of health (but in this case brain death) this case is not wanting the fetus to 'have a chance' because the mother is brain dead, was deprived of oxygen and the fetus also suffered the same fate and will not be what one would call a normal birth, assuming the fetus survives as a baby after birth. It does not appear that this is what one calls a viable birth so if the mother were still alive and knew that the child was deprived of oxygen, it is possible that she would simply want the DNR to go ahead as she had originally wished.

"Marlise Munoz and her husband are just the latest victims caught in the crossfire of abortion politics. Mandating that pregnant women stay on life support regardless of their wishes is a neat and easy way to establish the claim that the state has an interest in fetal life, even at the earliest stages, that overrides a pregnant woman's basic human rights. After all, brain death during pregnancy is incredibly rare, making these laws more symbolic in nature than pragmatic. If your goal is to legally enshrine the notion that pregnant women are incubators first and humans second, keeping their bodies alive to grow babies long after their minds are gone is a perfect way to do it.

Of course, rare doesn't mean impossible, as Marlise Munoz's family is discovering. "All we want is to let her rest, to let her go to sleep," Munoz's father, Ernest Machado, told the Dallas Morning News. "What they’re doing serves no purpose." The family reasonably fears that the loss of oxygen that was enough to destroy Marlise Munoz's brain probably did serious damage to her fetus.

To make it worse, by going public with their story, Munoz's family is being treated to a heavy dose of vicious anti-choice rhetoric. Erick Munoz has been the subject of ugly speculation online, with anti-choice commenters eagerly suggesting that he simply wants to "get rid" of his wife. The reality, however, is that by holding Marlise Munoz in this state, her family is not being allowed to lay her to rest and start the grieving process properly. Laws like this need to be overturned."

Wednesday January 8, 2014, 10:19 pm
Kit did that say she had this in writing?
I advise everybody to write out your wishes.
My husband told me he would want me to unplug him. I informed him to have it written out for his brother. I do not believe I have that right. Everybody believes differently, and though I agree the last wishes should be carried out,, they should be carried out by a family member who can follow through with them.
I feel terrible for this family and feel this should have been kept between the family. Not a judge and not public opinion.

Wednesday January 8, 2014, 11:03 pm
I would guess she made her choice about not wanting to be left on life support at some point before she became pregnant. It's pretty hard to guess whether she would have had a change of heart knowing that her child might survive if she was kept on life support but I would like to believe that she was a loving and decent enough mother to sacrifice her original wishes for the life of her baby. She might also be pretty pissed at her father for suggesting that she was only a host for a fetus, she is still just as much that baby's mother as she was before she was declared brain-dead, her father sure doesn't give her much credit as a mother.

Thursday January 9, 2014, 10:48 am
How much further can the war on women go-even beyond death--?! This is beyond a heartbreak and more than alarming the fact it applies in 31 states- your "rights"-nil-freedom of speech-assuming that INCLUDES a DNR-nil.
Hooray for the taxpayer financing such atrocities-I am speechless. (and happy WE have no such "laws" overruling any last will or equal declaration. -Simply incredible.

Saturday January 11, 2014, 12:14 am
Why are the hospital and doctors intefering with God's will? What part of the word ARTIFICIAL (life support) do they not understand? So they don't trust God's will? What is up with that?

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